Chronic conditions tied to severe Covid more common in southeast, rural US

Obesity. Diabetes. Heart disease. COPD. Kidney disease. These chronic medical conditions all raise the risk of suffering a severe case of COVID-19, but a new government report shows some parts of the United States are far more vulnerable to these risks than others.

In a review of more than 3,000 U.S. counties, researchers from the U.S. Centers for Disease Control and Prevention found that “the median county prevalence of any of five underlying medical conditions that increase the risk for severe COVID-19-associated illness was 47.2%, and prevalences were higher in counties in the southeastern United States and in more rural counties.”

It’s not surprising that the pandemic is hitting the southeast and rural communities particularly hard, because so many people in these areas suffer from obesity and the other medical conditions that can make COVID-19 severe, said Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City.

“What’s also clear is that we must allocate increased resources to populations in rural communities, which have a disproportionately larger percentage of chronic medical conditions. These communities are at higher risk for adverse outcomes and death from COVID-19 as transmission rates continue to increase,” Glatter added.

The CDC team acknowledged that in its report. “Health care in rural counties is often under-resourced, and rural communities might have limited access to adequate care, which could further increase risk for poor COVID-19-associated outcomes,” the study authors stressed.

The report, by Hilda Razzaghi of the CDC COVID-19 Response Team, and colleagues, was published July 24 in the CDC’s Morbidity and Mortality Weekly Report.

“We know that underlying medical conditions, especially obesity, increases the risk for adverse outcomes in patients with COVID-19,” Glatter said.

Studies specifically point out that obesity is a significant risk factor for severe disease, hospitalization and intensive care unit admission, particularly in younger patients with COVID-19, Glatter noted.

The most common condition tied to severe disease was indeed obesity, with a median county prevalence of 35%. This was followed by diabetes at nearly 13%, COPD at 9%, heart disease at 9% and chronic kidney disease at 3%, the CDC team found.

“As the pandemic continues, we must continue to focus not only on treatment but prevention of chronic medical disease, such as obesity, since this ultimately increases the risk of death and disability in those afflicted with COVID-19,” Glatter said.

“It also signals the importance of staying engaged with health care providers via telehealth or in-person visits to help monitor and evaluate people who may be at higher risk for poor outcomes,” he said.

The importance of preventive care—like wellness visits, immunizations, blood pressure screenings, blood sugar and cholesterol monitoring and depression—is more important than ever as the pandemic continues, Glatter said.

Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center in New York City, said the United States is in the grip of not only the coronavirus pandemic, but an obesity epidemic.

“We don’t have proof why obesity makes COVID-19 worse, but there’s several suppositions,” said Siegel.

“One is that when you have obesity, you’re making inflammatory chemicals. Those inflammatory chemicals may very well trigger or be associated with cytokine storm or the other inflammatory responses we see in COVID-19, including blood clotting,” he said. “And the other part of it is that you can’t fully inflate your lungs when you’re obese, and that could be playing a role.”

Also, obesity can increase the risk for the other conditions that appear to make COVID-19 severe, Siegel said. “Obesity is definitely related to hospitalization at any age,” he noted.

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COVID-19 severity is increased in patients with mild obesity

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More information: For more on COVID-19, head to the U.S. Centers for Disease Control and Prevention.

Journal information: Morbidity and Mortality Weekly Report

https://medicalxpress.com/news/2020-07-chronic-conditions-tied-severe-covid-.html

The impact of COVID-19 on patients with asthma: A Big Data analysis

Jose Luis Izquierdo, Carlos Almonacid, Yolanda Gonzalez, View ORCID ProfileCarlos Del Rio-Bermudez, Julio Ancochea, Remedios Cardenas, View ORCID ProfileJoan B Soriano

doi: https://doi.org/10.1101/2020.07.24.20161596

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

PDF: https://www.medrxiv.org/content/10.1101/2020.07.24.20161596v1.full.pdf

Abstract

Background: From the onset of the COVID-19 pandemic, an association between the severity of COVID-19 and the presence of certain medical chronic conditions has been suggested. However, unlike influenza and other viruses, the burden of the disease in patients with asthma has been less evident. Objective: This study aims at a better understanding of the burden of COVID-19 in patients with asthma and the impact of asthma, its related comorbidities, and treatment on the prognosis of COVID-19. Methods: We analyzed clinical data from patients with asthma from January 1st to May 10th, 2020 using big data analytics and artificial intelligence through the SAVANA Manager clinical platform. Results: Out of 71,192 patients with asthma, 1,006 (1.41%) suffered from COVID-19. Compared to asthmatic individuals without COVID-19, patients with asthma and COVID-19 were significantly older (55 vs. 42 years), predominantly female (66% vs. 59%), had higher prevalence of hypertension, dyslipidemias, diabetes, and obesity, and smoked more frequently. Contrarily, allergy-related factors such as rhinitis and eczema were less frequent in asthmatic patients with COVID-19 (P < .001). Higher prevalence of hypertension, dyslipidemia, diabetes, and obesity was also confirmed in those patients with asthma and COVID-19 who required hospital admission. The percentage of individuals using inhaled corticosteroids (ICS) was lower in patients who required hospitalization due to COVID-19, as compared to non-hospitalized patients (48.3% vs. 61.5%; OR: 0.58: 95% CI 0.44-0.77). During the study period, 865 (1.21%) patients with asthma were being treated with biologics. Although these patients showed increased severity and more comorbidities at the ear, nose, and throat (ENT) level, their hospital admission rates due to COVID-19 were relatively low (0.23%). COVID-19 increased inpatient mortality in asthmatic patients (2.29% vs 0.54%; OR 2.29: 95% CI 4.35-6.66). Conclusion: Our results indicate that the number of COVID-19 cases in patients with asthma has been low, although higher than the observed in the general population. Patients with asthma and COVID-19 were older and were at increased risk due to comorbidity-related factors. ICS and biologics are generally safe and may be associated with a protective effect against severe COVID-19 infection.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Grant COVID-19 UAH 2019/00003/016/001/005 from the University of Alcala (Spain).

https://www.medrxiv.org/content/10.1101/2020.07.24.20161596v1

Workers praise Disney virus safety, but will visitors come?

Every week, it seems, Kaila Barker, her husband and their five children change their minds about whether to travel from their home in Connecticut to Florida’sWalt Disney World as planned in September.

On the one hand, the lack of crowds means more opportunities to go on rides without long waits. On the other hand, Connecticut and Florida have implemented pandemic-related quarantines for each other’s residents and visitors, and the Barkers worry whether the Disney “magic” will get lost with mandatory mask-wearing for visitors and workers, temperature checks and no parades, fireworks shows or up-close “meet-and-greets” with costumed characters.

“We keep going back and forth. It’s such a hard decision to make,” Barker said last Tuesday.

Two weeks after Disney World started opening its theme parks for the first time since closing in March because of COVID-19, the Barkers’ quandary affects not only Disney World’s future but that of central Florida’s tourism-reliant economy.

More than 75 million visitors came to Orlando in 2018, mostly due to its reputation as a theme park mecca, which also includes Universal Orlando and SeaWorld Orlando. But the coronavirus has upended Orlando’s status as the most visited place in the U.S.

In the week that Disney World’sMagic Kingdom and Animal Kingdom started welcoming back visitors, occupancy of hotel rooms in the Orlando area was down more than 60% from the previous year, a much deeper drop than the state as a whole, which declined more than 41%, according to STR, which tracks hotel data.

Less than half of Disney World’s 43,000 unionized workers have been recalled to their old jobs, contributing to two Orlando-area counties having the state’s highest unemployment rates last month — Osceola at 22.9% and Orange at 17.2%. Disney World has an overall workforce of 77,000 employees, the nation’s largest single-site labor force.

Many of those still-furloughed workers are about to lose federal benefits at the end of the month.

“This is an extremely difficult moment,” said Paul Cox, president of the local union that represents stagehands and show technicians at Disney World. “There are still a majority of workers who are staying at home and they’re about to lose support. Things are going to get bad.”

Union officials estimate the Disney parks are no more than a third full, but that may be more by design to maintain social distancing. Disney World doesn’t release attendance figures, but in pre-pandemic times its four parks and two water parks could host around 150,000 visitors a day.

Florida has had a surging coronavirus caseload recently, and other Disney parks around the globe have run into coronavirus-related roadblocks. Hong Kong Disneyland Park was forced to close earlier this month following the city’s decision to ban public gatherings of more than four people, and Disney’sCalifornia parks delayed reopening while they awaited state guidelines.

Cowen Inc. estimated recently that Disney’s parks and resorts won’t return to pre-pandemic profitability until fiscal year 2025, and there is a “meaningful” probability that Disney World could close again because of the pandemic.

Leaders of the Disney World workers’ unions describe the virus-related safety measures Disney has taken as “exemplary.”

After workers complained about patrons walking around with their masks pulled down while eating food like turkey legs, Disney World updated its mandatory mask policy, requiring visitors to eat in one place while maintaining social distancing.

In response to other worker concerns, Disney has distributed personal hand sanitizer containers for workers to wear on their belts, added additional break rooms to limit the number of workers in them and reduced the number of riders on buses that shuttle workers from parking lots to the parks. Performers dressed as Disney princesses being driven in a horse-powered carriage through the parks now sit individually in rows separated by clear-plastic window partitions.

“Singing their praises seems so strange,” said Julee Jerkovich, an official with a United Food & Commercial Workers union, which represents Disney merchandise and banquet workers. “As far as this grand experiment, I would have to say Disney has done a really good job.”

But not all unions are happy. The union that represents actors and singers has filed a grievance with Disney World, saying their 750 members were locked out of returning to work after they complained about Disney ignoring their demands for getting coronavirus tests since they can’t wear masks while performing. Some performers, though, are eager to return to work and are pushing the union to reach an agreement with the company, as they worry about Disney replacing their shows with temporary ones featuring non-actors.

There have been isolated cases of workers and visitors connected to the theme parks getting sick with COVID-19, “but we haven’t seen any large number of positive cases that come from any of the parks,” Dr. Raul Pino, health officer for Florida’sDepartment of Health, said last Monday.

Disney’s policy of granting sick workers with paid time off so they can quarantine has made a difference, said Eric Clinton, president of Unite Here! Local 362, which represents Disney World park greeters, attractions workers and custodians.

But Clinton wonders if the current operating model can last until the pandemic is over, given that just over 20,000 of the 43,000 workers represented by unions have returned to work, only half of Disney World’s 30 onsite hotels currently are back open and several in-park restaurants still are closed.

“Disney is a strong brand. They have a great product, but does the novelty wear off? Do people want to go to a theme park now? Is it more appealing with less crowds?” Clinton said. “I’m hopeful but nervous.”

https://www.marketscreener.com/WALT-DISNEY-COMPANY-THE-4842/news/Walt-Disney-Workers-praise-Disney-virus-safety-but-will-visitors-come-30992897/

Coronavirus Rages on Coasts as Hurricane Fears Rise

Hurricane-prone states are experiencing some of the nation’s sharpest increases in COVID-19 infections, raising fears that a major storm will have deadly consequences if people in its path refuse to evacuate to avoid contagion.

The number of infections nationwide has more than doubled since the start of hurricane season on June 1, passing 3.8 million yesterday.

The increase has been especially dramatic in Southeastern states on the Atlantic and Gulf coasts, federal data shows, leaving hospitals strained and people potentially wary of finding shelter during a hurricane or staying with friends or relatives.

A surge in COVID-19 cases also could complicate hurricane recovery by prompting the Federal Emergency Management Agency to avoid sending disaster relief workers into pandemic hot spots.

In Florida, the number of infections has soared to 360,000 from 57,000 on June 1—the largest increase of any state in the past seven weeks.

“This is the epicenter of the nation right now, the hurricane coast,” said James Shultz of the University of Miami’s Miller School of Medicine.

Florida’s virus spike has left just 22% of the state’s 60,000 hospital beds empty, state records show.

The vacancy rate is even lower in vulnerable coastal counties such as Broward in South Florida, where just 16% of hospital beds are available, and Miami-Dade, where 18% of beds are available.

Florida has experienced more hurricane disasters than any other state since the 1950s and is still rebuilding from Hurricanes Michael in 2018, Irma in 2017 and Matthew in 2016.

“If we have continued hospitalizations and we have a hurricane, it’s really going to tax resources here significantly,” said Attila Hertelendy, a professor at Florida International University in Miami and a former hospital administrator.

In Texas, the number of COVID-19 infections has increased to 346,000 from 65,000 on June 1—the third-largest increase of any state after Florida and California.

Patients now fill 19% of Texas’ 55,000 hospital beds—a dramatic jump from June 1, when they occupied only 3% of the beds, state figures show.

Altogether, just 20% of Texas hospital beds are vacant. In the Houston area, which was devastated by Hurricane Harvey in 2017, the vacancy rate is 13%.

Texas has had more hurricane disasters than all but three states, federal records show.

North Carolina, which ranks second in hurricane disasters, has seen its COVID-19 infections more than triple since June 1, from 29,000 to 101,000.

In Louisiana, which ranks third in hurricane disasters, infections have more than doubled to 95,000 from 40,000.

‘Inconsistent messaging’

The surge in virus cases has come amid an alarming early hurricane season that saw a record six tropical storms form in the Atlantic by early July. NOAA projects a highly active season, including three to six hurricanes with winds of at least 111 mph, and says that high sea surface temperatures could be fueling storms.

“If we’re in a season where the environment is conducive to storm formation early on, then those underlying favorable conditions often persist throughout the season,” NOAA atmospheric scientist James Kossin said in a recent release by NASA Earth Observatory.

The contagion could encourage people to shelter in place during a hurricane and negate efforts by states and relief groups to make storm shelters safer by redesigning them with more space for each person.

The American Red Cross, which handles disaster sheltering along with FEMA, is doubling the amount of space it allocates for each person in a congregate shelter, from roughly 55 feet to 110 square feet.

Miami-Dade County plans to have 82 shelters available during this hurricane season—far more than the 20 shelters it opened during Hurricane Irma, according to the Miami Herald. At converted schools, evacuees will stay in classrooms instead of gymnasiums to enhance social distancing.

But the precautions may not assuage people who are wary of evacuating during a hurricane—or make them safe from the coronavirus if they do go to a shelter, experts said.

“We are not going to have the compliance that we had in the past in Florida,” said Hertelendy, the Florida International professor. “Even with a Cat 5 [hurricane], I think they would try to ride it out.”

In addition to being afraid of contracting the virus in a shelter or at a relative’s house, people are warier than ever of government orders after hearing conflicting advice about how people should deal with the pandemic, Hertelendy said.

“Because we have such inconsistent messaging on COVID, we have a population group that is very skeptical,” Hertelendy said. “People are not in the mood to leave their homes under the best of circumstances.”

People who shelter in place during a powerful hurricane risk death both during and after the storm.

“If you don’t evacuate and end up with long power outages, particularly with vulnerable population groups, people could end up dying,” Hertelendy said. “That’s a very realistic outcome.”

As COVID-19 has exploded across the United States, new research about transmission suggests that the 6-foot distancing that officials have urged may be insufficient.

A new research paper says 6 feet of separation “is likely inadequate, particularly in enclosed spaces like shelters.”

Shultz, the University of Miami professor, is the lead author of the study, which suggests that the coronavirus can become aerosolized, enabling it to travel farther than was previously thought.

“Aerosols can travel a lot farther than 6 feet,” Shultz said.

The surge in infections also could complicate hurricane recovery by prompting FEMA to use remote technology instead of site visits to evaluate damage to homes and infrastructure. FEMA uses the evaluations to decide how much money—if any—to give individuals and communities after a disaster.

“While COVID-19 morbidity and mortality persist, FEMA will generally minimize the number of personnel deploying to disaster-impacted areas,” the agency wrote in a recent guidance for the 2020 hurricane season. “If personnel deploy to the field, FEMA will use as few personnel as possible to ensure social distancing.”

https://www.scientificamerican.com/article/coronavirus-rages-on-coasts-as-hurricane-fears-rise/